Debunking 5 Prevalent Swine Flu Myths

Fall is here, and with it comes another new flu season. Experts are predicting that the H1N1 strain of influenza—or, what we've been calling the swine flu—could come roaring back after a relatively quiet summer. The possibility of a new surge of flu cases makes this a good time to examine some of the myths that have been circulating about H1N1 in the last few months.

The details: H1N1 is a new strain of flu, and it includes parts of four other flu strains: human flu and avian flu, as well as both North American and Eurasian swine flu. Some theories circulating online argue that this combination of strains is so unlikely that the new virus must have been created by humans in a lab and then either accidentally or deliberately released.

The facts: "There's absolutely no evidence that this was created by a human hand," says William Schaffner, an infectious disease specialist at Vanderbilt University.

In part, the myth persists because of the assumption that H1N1 could not have evolved naturally. This is untrue: "There are many, many species of influenza out there and they happily recombine," says Nicole Baumgarth, an immunologist at the University of California, Davis. Pigs, in particular, have proven to be extremely good "mixing bowls" for the influenza virus, Schaffner says. They are easily infected by strains from a variety of sources--humans, birds and more--and they live in extremely close proximity, passing strains between themselves often. And once inside the pig, the various strains of flu will happily swap bits of DNA, creating brand new strains.

This recombination happens extremely often, but because this remixing is random, most of the new viral combinations are dead ends, incapable of surviving or replicating. Every once in a while, of course, the random remix turns out to be viable, and a new flu strain is born.

The details: A corollary of the created-in-a-lab assertion, this myth holds that H1N1 was created to cause mass casualties. The specific details vary, but the underlying idea is the same: Some government or military or terrorist group created the new strain as a biological weapon they could use to fell their enemies.

The facts: "The Flu has no characteristics--none, zero--that make it attractive to a biological terrorist," Schaffner says. And H1N1 is no exception. It's not nearly as lethal as many other bioterrorist agents, and it's almost impossible to control. There's no telling who will get sick, how many will get sick, or how many of them will die. And once the virus is released, it could easily take on a life of its own. "It's unpredictable how it works," Schaffner says. "It could blow back on your own people."

The details: Most of the early fatalities from H1N1 were Hispanic patients. Some have suggested that the virus is--either by design or by accident--naturally more contagious among, dangerous for or lethal to Hispanics.

The facts: "Early on, there was an emphasis on illness in Hispanics," Schaffner says, "but it's spread way beyond that population now. The initial reason for that was simple geography." H1N1 first emerged in Mexico and then spread to parts of the U.S. with large Hispanic populations, including Texas, New York and New Jersey. So yes, Hispanics were disproportionately affected in the early stages of the outbreak.

But H1N1 has now spread way beyond that. There have been cases in dozens of countries, on every continent except Antarctica, and in people of many backgrounds and ethnicities. (There have been hundreds of deaths among Asians.) Not only is it not true that it's more lethal to Hispanics, but experts say they can't even imagine a potential strain of flu that would selectively strike people of a certain ethnicity. "You can't control flu," Schaffner says. "It can't target just people with red hair or people who are left handed."

The details: It's not the flu we need to worry about, some say--it's the vaccines. These people worry that the government will show up at each and every doorstep, requiring every citizen to get an H1N1 vaccine. Some members of the public have even confessed that they are more worried about the dangers of a vaccine than of the flu itself.

The facts: There is no government mandate to get a flu vaccine. "There's no way the government can require it," says Peter Katona, an infectious disease specialist at UCLA. With one exception: New York is now requiring health care workers to get the H1N1 vaccine when it becomes available, and other states could follow suit. The goal is to protect patients--a health worker infected with a mild case of H1N1 could create disaster if she passes it along to a patient already fighting other serious illnesses.

But for the rest of us, vaccination for H1N1-- which will be available beginning in October--will be completely and utterly voluntary. It will also be free. The government bought the H1N1 vaccines in bulk and will begin distributing them to doctors and health clinics in October. Right now, the CDC is not recommending that everyone get the vaccination--it's specifically recommending it for high-risk groups, including children, parents of infants, pregnant women, health care workers and adults with underlying health problems. The government has only ordered 195 million doses for more than 300 million Americans; even if everyone wanted it, there wouldn't be enough to go around.

What's more, worries about the vaccine's safety are generally overblown, experts say. The vaccine, currently being evaluated in clinical trials, is going through a rigorous approval and trial process, and the commonly held myth that it could give a patient the flu is false. Most of the H1N1 vaccines are designed to be injected into the arm and contain an inactivated flu virus. "It's actually destroyed," immunologist Nicole Baumgarth says. "It cannot replicate and you absolutely cannot be infected by that virus." A smaller number of vaccines will be nasal sprays containing what is known as an attenuated virus. The version of the virus the spray contains is temperature sensitive and can replicate in the nose but not in the warmer internal organs, such as the lungs. Confining the virus to the nose keeps it from actually causing influenza-based illness, Baumgarth says, but the vaccine is still powerful enough to create immunity.

"There's a lot of hysteria about vaccination," Katona says. "But on the whole, in the years since we've been vaccinating, the positives of vaccinations have way outweighed the negatives." The H1N1 vaccine "looks like it will be an effective tool in the fall."

The details: Bloggers and others have suggested that the H1N1 threat has been hugely overhyped. Some have said that officials unknowingly overreacted at the first signs of an outbreak; others suggest that there was a more deliberate and intentional attempt to play up the danger to achieve some political goal. Either way, proponents of this idea point to the relatively low levels of damage that H1N1 has so far inflicted or highlight individual patients' stories about how mild their symptoms were.

The facts: The initial, full-throttle reaction from public health officials was in the public's best interest. "It's wise to be prepared for the worst," Katona says. "And I think that's what the government's doing. Those people who say, `Oh there's nothing to worry about,' are being, in my view, foolish. We don't know what will happen."

But it's also wrong to assume that H1N1 will continue to be as benign as it has been so far. Spring and summer are generally slow seasons for flu, and as we head into the fall, experts expect the number of H1N1 cases to escalate. In fact, there's already evidence of this, particularly of outbreaks at schools and universities. For instance, the New York Times reported last week that some 2000 Washington State University students were showing signs of H1N1 infection; the outbreak reportedly started during fraternity and sorority rush at the school. "As the schools have reconvened, as the universities have started up again, where we take the most susceptible portions of the population and confine them for long periods of time, that's a recipe for influenza," Schaffner says. "We're not out of the woods by a long shot."

H1N1 could also always mutate to become more dangerous. "Viruses have a mind of their own," Katona says. "We just don't know."

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